Management Final

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Steps to resolve conflict
(6)

1. Seperate facts from opinion

2. Identify the specific problem

3. Seek suggestions and ideas from those involved

4. Select the solutions that settle disagreement

5. Note the consequences of the solution

6. Evaluate the success in resolving conflict

What needs to be charted?
(5)

- Focused assessments at the beginning & end of shift

- Nursing care/treatments

- Patient response to everything

- Any abnormal labs - with follow up

- Everything that will add to the big picture your documentation is painting

Means each individual is responsible and accountable for his/her own actions

Personal liability

It allows the courts to hold the employer responsible for the actions of an employee when the employee is performing services for the organization within his/her scope of practice

Vicarious liability

This refers to the responsibility of the organization for its own wrongful conduct. This includes the duty to: hire, supervise, & maintain qualified competent, adequate staff; provide, inspect, repair, & maintain reasonable equipment; and maintain safety in the physical environment.

Corporate Liability

Four elements of malpractice

Duty

Breach of Duty

Harm/Injury

Proximate Cause

Patient injury + Willing lawsuit = ???

Lawsuit

Basic assumptions or personal convictions of what is truthful or factual

Beliefs

The standards or guidelines for acceptable behavior

Morals

Judgments or beliefs about the worth of objects, attitudes, and attributes

Values

Determines what is right or wrong based on unchanging, absolute moral principles and values, and one’s duty or obligation to act in a given situation.

Deontology

Determines the rightness or wrongness of an action based on its consequences for the general welfare of all people if all people acted in a similar manner in the same situation.

Teleology

After mixing alcohol and sedatives at a party in 1975, an 18 year-old suffered cardiopulmonary arrest and subsequently entered a chronic persistent vegetative (PVS) state. The father, opposed by doctors, the hospital, a court-appointed guardian, the county prosecutor, and state of New Jersey, sought to be made the guardian and sought authorization to discontinue life-sustaining processes

Karen Ann Quinlan (1976)

This was the first court case to specifically deal with withdrawing ventilatory support from a permanently unconscious patient who was not “brain dead”.

Karen Ann Quinlan (1976)

The right of competent patients to refuse treatment was affirmed. Foregoing artificial nutrition and hydration is not different than foregoing other forms of treatment. The state of Missouri could require continued treatment of a patient in a persistent vegetative state unless there was “clear and convincing” evidence that the patient had explicitly authorized the removalof the treatment before the incident.

Nancy Beth Cruzan (1990)

What was the first case concerning foregoing of life-sustaining treatment to reach U.S. Supreme Court.

Nancy Beth Cruzan (1990)

This patient suffered severe brain damage during a cardiac arrest in 1990 as a result of a chemical imbalance reportedlydue to an eating disorder. The husband, who wanted the feeding tube removed, and the parents, who did not. As a result, they were locked in controversy and legal battles over the course of a seven-year struggle to make that decision.

Terri Schiavo (1995)

A patient in a California hospital, requested that she be allowed to refuse her tube feedings and be kept comfortable. She suffered with severe cerebral palsy, sought legal recourse when the hospital announced its intention to force-fed her or transfer her to another hospital.

Bouvia v. County of Riverside (1983)

This case is the foundation for all current practices regarding informed consent. The patient did not receive an explanation of the risks of a surgery. The California Supreme Court outlined how informed consent should be handled and upheld the patient’s right to exercise control over his/her body and to make reasonable decisions forhimself/herself

Cobbs v. Grant, 1972

the right to make decisions about one’s own healthcare

autonomy

the requirement to do no harm to others either intentionally or unintentionally

Nonmaleficence

the obligation to do good

Beneficence

the obligation to be fair to all people

Justice

one’s faithfulness or loyalty to agreements and
responsibilities that one has accepted

Fidelity

securing and protecting the privacy of others

Confidentiality

requirement to communicate truthfully and
accurately

Veracity

linked to fidelity and means accepting responsibility for one’s action

Accountability

Key concepts of the ANA Code of Ethics include:

1. Practice characterized by compassion and respect for dignity, worth, and uniqueness of every individual

2. Primary commitment to the patient

3. Patient advocacy

4. Individual responsibility and accountability for practice

5. Duty to maintain competence

6. Provision of quality health care

7. Participation in advancement of the profession

8. Collaboration with other health professionals

9. Collective responsibility for maintaining the integrity of the profession and its practice

brief excursions across professional boundaries that may be inadvertent or purposeful. Thereis a return to established limits of the professional relationship after the crossing has occurred.

Boundry Crossings

phenomena that occur when there is confusion about client versus professional needs. Theseboundary issues are typically characterized by a reversal of roles, secrecy, the creation of a double bind for the client,and indulgence of personal privilege by the professional.

Boundry Violations

the use of power, influence, and/or knowledgeinherent in the nurse’s position to obtain sexual gratification, romantic partners, and/or sexually deviant outlets

Professional Sexual Misconduct

Anybehavior by the nurse that is seductive, sexually demeaning, harassing, or reasonably interpreted as sexual by theclient is considered professional sexual misconduct.

Professional Sexual Misconduct

This boundary violation occurs when the nurse initiates sexual interaction with a client or responds to a client in a sexual manner, including sexually suggestive or explicit comments,off-color jokes, obscene phone calls/letters, non-therapeutic hugs, indecent exposure, and overt sexual acts.

Professional Sexual Misconduct

Contracts with provider network for discount rates in return for patient referrals. No outside of network paid unless pre-authorized. PCP must referr to a specialist. Very restrictive with least choice of providers, but large range of health benefits with very little co-pay.

HMO's

Contracts with providers like HMO, but no PCP required. Services outside of network cost more but a portion will be covered. Usually no referral for a specialist. More choice but higher out of pocket expences.

PPO's

HMO/PPO hybrid. Choose which type each time health care sought. Ecourage PCP but not required. Lower copay if use PCP.

POS plan

A type of civil law that particularly affects nurses

Unintentional Torts

A licensing law created to protect the public

Statutory law

The type of law violated with illegal possession of drugs

Criminal Law

The type of law based on the outcomes of previous cases that may be used in a malpractice case involving nurse liability

Common Law

The failure of a professional to meet standards of care resulting in harm to another person

Malpractice

What legal principle may contribute to a hospital staff nurse's decision to not carry professional liability insurane?

A physician wrote an order for lovenox, 40mg sq q 12 hrs, on a patient scheduled for a liver biopsy the next day. The nurse called the physician to verify the order and avoided which type of error in the area of litigation risk?

Evaluation

A patient on fall precautions was left in bed with the side rails down while the nurse stepped out to get fresh linens. The patient tried to get up, fell and fractured his hip. In the area of litigation risk, which type of error did the nruse make?

Planning

How do you calculate the renewal date of new license?

It will be the last day of the nurse's birth month. If they were born in an odd year, the license will need to be renewed in an odd year, same with even years.

How long do you have to pass the NCLEX after graduation? How many times can you take it?

4 years

As many as needed

How many hours of continuing education must be completed and how long do you have to do it?